[Provider] Improvements for MaineCare Primary Care Providers

[Provider Notification]

ATTENTION:  All MaineCare Primary Care Providers

The following message is a letter from Tony Marple, Director of the
Office of MaineCare Services.  It is being mailed to all primary care
providers.

 

 

 

Dear Primary Care Provider, 

 

Several improvements for MaineCare - including higher fees for certain
services - were funded in the 2007 State budget.  Rulemaking for these
changes is underway now.  The proposed rules: 

 

*        increase the MaineCare reimbursement rate for certain services
from 53 percent to 61.7 percent of Medicare's January 2008 rate
(Services that are billed with CPT codes as fee-for-service will get the
increase.  Providers who get cost settlements, bill with local codes,
radiologists , FQHCs and RHCs will not be affected); 

*        add coverage for fluoride varnish for patients under age 21; 

*        increase the primary care case management (PCCM) fee from $2.50
to $3.50 per member per month;

*        expand PCCM membership by around 25,000 members; that's a 15%
increase in the PCCM membership.  The expansion will happen in phases
over a few months one county at a time;

*        add a requirement for a care plan overseen by the physician for
members who have chronic conditions to help keep members as healthy as
possible.   Care Plans are for members who have chronic obstructive
pulmonary disease, asthma, cardiovascular disease, depression and/or
diabetes. and 

*        drop the requirement that PCP's manage audiology, speech and
hearing services.  

 

All of these changes take effect on July 1, 2008.  We will give you more
specifics on these changes in separate communications.    (Note: some
changes will be finalized later this year, and then made retroactive to
July 1.)  Rules and rulemaking documents are available on the MaineCare
website (http://www.maine.gov/dhhs/bms/) .  Questions about policies?

Call 1-800-321-5557.  

 

Thank you for your commitment to providing quality care for MaineCare
members. 

 

 

This is a one-way communication.  Please do not respond to this message.

 

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